Adding Lunesta to fluoxetine therapy appears to enhance improvement in symptoms of depression, insomnia
The combination of Sepracor Inc.'s Lunesta (eszopiclone) and fluoxetine appears to improve the symptoms of insomnia and depression to a greater degree than does fluoxetine monotherapy, according to data from a co-administration study.

Dr. Andrew Krystal, director of the sleep research laboratory and insomnia program at Duke University Medical Center in Durham, N.C., led the study, which included 545 patients aged 21 to 64 years who had comorbid insomnia and depression. Eligible patients had major depressive disorder and insomnia associated with the disorder. They also had a score greater than 14 on the 17-item Hamilton Rating Scale for Depression (HAMD-17) at the initial visit (mean baseline score, 22), sleep latency greater than 30 minutes, wake after sleep onset durations of more than 45 minutes and less than 6.5 hours of total sleep time. ?

After a one- to three-week lead-in period, all patients received a daily dose of 20 mg to 40 mg of fluoxetine plus double-blind Lunesta 3 mg (n=270) or placebo (n=275) each night at bedtime for eight weeks. A two-week run-out period followed the treatment phase, during which patients continued to receive fluoxetine and single-blind placebo.

The research team found that the group treated with Lunesta plus fluoxetine experienced significant improvements in those items of the HAMD-17 that measured insomnia.

Further, treatment with Lunesta resulted in improvements in multiple items associated with core depressive symptoms as compared with treatment with fluoxetine monotherapy. These improvements increased during the treatment phase, and, of particular interest, they continued to increase even after treatment with Lunesta was stopped.

Specifically, after four weeks of treatment, significant differences between the Lunesta and placebo arms were noted in the total HAMD-17 score and on the individual items measuring insight and early, middle and late insomnia relative to baseline.

After eight weeks of treatment, patients in the Lunesta group showed significantly greater improvements in the total HAMD-17 score, all three of the insomnia items, feelings of guilt, work and activities and psychic anxiety.

Even at 10 weeks, after the run-out phase, the group that had been treated with Lunesta demonstrated significantly greater improvements from baseline as compared with the fluoxetine-only arm in total HAMD-17 score; early, middle, and late insomnia; feelings of guilt; work and activities; psychic anxiety (but not somatic anxiety); retardation; agitation; general somatic symptoms (but not gastrointestinal symptoms); and hypochondriasis.

Dr. Krystal told VerusMed that, had treatment with Lunesta been extended beyond the eight weeks in this study, the observed improvements probably would have continued.

"It was not just that there was no rebound [after stopping Lunesta]," he said. "[The patients] didn't go back to baseline. They stayed at the improved level."

Lunesta is a nonbenzodiazepine approved for the treatment of insomnia. Fluoxetine is approved to treat depression, obsessive-compulsive disorder, some eating disorders, panic attacks and to relieve the symptoms of premenstrual dysphoric disorder.

These data were presented at the 20th Anniversary Meeting of the Associated Professional Sleep Societies in Salt Lake City, Utah.

Thanks for the info--this is an interesting study that I'd not heard about. Certainly insomnia and depression go hand in hand, and one makes the other worse. While Prozac (fluoxetine) can be the very thing for depression, many find that it does not improve the insomnia that goes with depression and may, in fact, make it worse.

I've had good luck with Lunesta in sleepless patients. The one downside of this medication is that occasionally it can cause a nasty taste, akin to a small animal creeping in to your mouth in the night and dying there. Most do not experience this side effect.

This study highlights the trend towards treating depressed persons with more than one medication at a time. This is not necessarily because those treated have particularly severe depression but rather the increasing realization that multiple areas of the brain are affected by mood disorders, and no one drug addresses all the problems that arise.

Dr Judy
I'd take the possibility of a nasty taste over the sleep driving and eating that I've heard associated with Ambien (heard from one of our customers, caught twice by a neighbor policeman). LOL
Seriously, the sleepless/depression cycle is horrible, I had a bit of luck calming my monkey-mind with Lexapro but still had a large time-frame of early waking (only 1/2 hour to 3 hours of sleep a nite on average for about a month, talk about fuzzy brain!!! and overall not feeling well) I tore up my prescription for Ambien secondary to hearing about the side effects but would consider this. I'm having a great period of being able to stay asleep now going on about a month with no help (no Lexapro or anything) so here's knocking on wood it stays that way!!!

Hugs Pam

It's never too late for a happy childhood!!
The more you live, the less you die!!
Well behaved women rarely make history.
DB: 1958
peri/hypothyroid/fibroids(myomectomy)
Pam

minniepauz wrote:Thursday, June 22, 2006 in Health Care Business Daily

Adding Lunesta to fluoxetine therapy appears to enhance improvement in symptoms of depression, insomniaThe combination of Sepracor Inc.'s Lunesta (eszopiclone) and fluoxetine appears to improve the symptoms of insomnia and depression to a greater degree than does fluoxetine monotherapy, according to data from a co-administration study.

Dr. Andrew Krystal, director of the sleep research laboratory and insomnia program at Duke University Medical Center in Durham, N.C., led the study, which included 545 patients aged 21 to 64 years who had comorbid insomnia and depression. Eligible patients had major depressive disorder and insomnia associated with the disorder. They also had a score greater than 14 on the 17-item Hamilton Rating Scale for Depression (HAMD-17) at the initial visit (mean baseline score, 22), sleep latency greater than 30 minutes, wake after sleep onset durations of more than 45 minutes and less than 6.5 hours of total sleep time. ?

After a one- to three-week lead-in period, all patients received a daily dose of 20 mg to 40 mg of fluoxetine plus double-blind Lunesta 3 mg (n=270) or placebo (n=275) each night at bedtime for eight weeks. A two-week run-out period followed the treatment phase, during which patients continued to receive fluoxetine and single-blind placebo.

The research team found that the group treated with Lunesta plus fluoxetine experienced significant improvements in those items of the HAMD-17 that measured insomnia.

Further, treatment with Lunesta resulted in improvements in multiple items associated with core depressive symptoms as compared with treatment with fluoxetine monotherapy. These improvements increased during the treatment phase, and, of particular interest, they continued to increase even after treatment with Lunesta was stopped.

Specifically, after four weeks of treatment, significant differences between the Lunesta and placebo arms were noted in the total HAMD-17 score and on the individual items measuring insight and early, middle and late insomnia relative to baseline.

After eight weeks of treatment, patients in the Lunesta group showed significantly greater improvements in the total HAMD-17 score, all three of the insomnia items, feelings of guilt, work and activities and psychic anxiety.

Even at 10 weeks, after the run-out phase, the group that had been treated with Lunesta demonstrated significantly greater improvements from baseline as compared with the fluoxetine-only arm in total HAMD-17 score; early, middle, and late insomnia; feelings of guilt; work and activities; psychic anxiety (but not somatic anxiety); retardation; agitation; general somatic symptoms (but not gastrointestinal symptoms); and hypochondriasis.

Dr. Krystal told VerusMed that, had treatment with Lunesta been extended beyond the eight weeks in this study, the observed improvements probably would have continued.

"It was not just that there was no rebound [after stopping Lunesta]," he said. "[The patients] didn't go back to baseline. They stayed at the improved level."

Lunesta is a nonbenzodiazepine approved for the treatment of insomnia. Fluoxetine is approved to treat depression, obsessive-compulsive disorder, some eating disorders, panic attacks and to relieve the symptoms of premenstrual dysphoric disorder.

These data were presented at the 20th Anniversary Meeting of the Associated Professional Sleep Societies in Salt Lake City, Utah.

As you can see I have done nothing today but sit on my tush and read this board whilst watching Lifetime Movies...perfect day really, lol. I know this post is 3 years old but I found it interesting. I may mention it to my Dr. who just put me on Prozac. Have you heard anything further on this since then??

"Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos to order, confusion to clarity. It can turn a meal into a feast, a house into a home..."

colopam wrote:Dr JudyI'd take the possibility of a nasty taste over the sleep driving and eating that I've heard associated with Ambien (heard from one of our customers, caught twice by a neighbor policeman). LOLSeriously, the sleepless/depression cycle is horrible, I had a bit of luck calming my monkey-mind with Lexapro but still had a large time-frame of early waking (only 1/2 hour to 3 hours of sleep a nite on average for about a month, talk about fuzzy brain!!! and overall not feeling well) I tore up my prescription for Ambien secondary to hearing about the side effects but would consider this. I'm having a great period of being able to stay asleep now going on about a month with no help (no Lexapro or anything) so here's knocking on wood it stays that way!!!

Hugs Pam

Again, I know an old thread, however, for a second opinion regarding Ambien from someone who uses it, I can tell you there are many of us who do not get those side effects. I take a 1/2 an Ambien as needed and I wake up feeling refreshed and not drugged up at all. Now, I wouldn't recommend it every single night if you can help it, just because I am not sure of side effects or if there are any kind of withdrawal symptoms, though, I have taken it at one point for a month when I had a particularly difficult month in the sleep dept. I was fine when I didn't take it, didn't seem to suffer withdrawals. But, that may not be the case for everyone.

"Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos to order, confusion to clarity. It can turn a meal into a feast, a house into a home..."

I was way past the menopause insomnia problems and was diagnosed with severe sleep apnea. In March this year I finally managed to get a cpap machine (I wear a mask at night and it forces me to keep breathing) and I cannot believe the difference it's made in my life! I sleep a solid 6-8 hrs. without even getting up to go to the bathroom, I wake up refreshed instead of yawning within 30 min. and I don't have to take any naps during the day. It's wonderful.

I would recommend anyone who snores and is maybe a bit overweight (and who has insurance) to get a sleep test and a machine! Seriously it can change your life.

NEW YORK (Reuters Health) - People with insomnia who are actually getting very little sleep have a sharply higher risk of high blood pressure than their peers who have no trouble catching Z's, new research shows.

The findings make it clear that insomnia can have real medical consequences, and is not just a disorder of the "worried well," Dr. Alexandros N. Vgontzas, director of the Sleep Research and Treatment Center at the Penn State College of Medicine in Hershey, told Reuters Health.Read more here:http://uk.reuters.com/article/healthNew ... OR20090401